Cancer of the esophagus - Causes, Symptoms and Treatment .MF .
cancer The causes of esophageal cancer are some features of food: abuse too hot and spicy food, including beverages, the use of smoked and cured meat and fish products containing small bones (steak), injuring the mucous membrane of the esophagus, chewingNASA and tobacco, alcohol.Important role played by smoking in esophageal cancer development, as a smoker swallows not only cigarette smoke, but also harmful substances deposited on the oral mucosa.Smokers, heavy drinkers, the risk of esophageal cancer increases 100 times.In the development
esophageal tumors plays an important role in nutrition deficiency of vitamins A, B, C, and E, as well as certain micronutrients (molybdenum, selenium, folic acid).
Among other factors: chronic diseases of the esophagus, such as chronic esophagitis (inflammation), erosion and ulceration of the esophagus associated with reflux in the esophagus lumen irritating stomach contents (reflux esophagitis) and prolonged exposure to carcinogenic factor in th
esophagus Damage: chemical and thermal burns, exposure to metal dust (arsenic, chromium, nickel), asbestos, combustion products, as well as scar processes in the body;polyps (benign tumors);some other chronic and hereditary diseases of the esophagus (Barrett, achalasia and tylose).With the development of esophageal cancer often has a genetic predisposition.
Symptoms of esophageal cancer are divided into:
1. nonspecific: weakness, sweating, body temperature rises, reduction or loss of appetite, weight loss.
2. specific for cancer of the esophagus:
- difficulty swallowing (dysphagia) - initial - for breach of the passage of solid and roughage before the breach and the fluid passage until the complete obstruction (even water);
- pain in the chest or in the back, between the shoulder blades as a result of inflammation and ulceration of the mucosa, at the last stage of the disease the pain caused by tumor invasion into adjacent organs or large nerve trunks of the chest;
- excessive salivation, accumulation of saliva over the tumor (with involvement of the major nerves of the chest cavity);
- hoarseness associated with paresis (immobility) of the vocal folds as a result of the germination of the large nerve plexus thoracic cavity;
- cough, hoarse, dry, sometimes it can be a purulent or bloody sputum, as a result of sprouting tumor of the trachea or bronchi.
last group of symptoms characteristic of the disease running stages.By building
isolated squamous cancer of the esophagus and adenocarcinoma (from glandular cells).The shape of the tumor growth is divided into: the cancer grows in the body lumen (exophytic), growing along the body wall (endophytic) and mixed forms of growth.
By location distinguish:
- Cancer of the upper esophagus - the cervical, thoracic and medium;
- cancer of the lower esophagus - the lower thoracic and pischevodno- gastric junction.
stages of esophageal cancer:
Stage 1: swelling up to 3 cm, and only affects slizituyu esophagus;
Stage 2: tumor size 3 to 5 cm and the presence of metastases in the surrounding limfatichesikih nodes;
Stage 3: size from 5 to 8 cm, and the entire thickness of the wall of the body, as well as the presence of metastases in the surrounding lymph nodes;
Stage 4: the length or size of the tumors more than 8 cm, moving it to nearby organs (increase in lung, trachea or bronchi, the great vessels), as well as the presence of metastases in other organs.
metastasized esophageal cancer, especially in the nearby lymph nodes distant organs of metastasis often affects the lungs, liver and bone as well as may provide intramural tumor screenings (as esophageal wall).
complications of esophageal cancer:
Hemoptysis - discharge of blood clots with phlegm (during germination tumor of the bronchi and trachea).Dangerous bleeding from the tumor up to the intense, leading to death of the patient.When tumors of large size, germinating nearby organs may develop fistulas (report their holes that are not in normal organs), such as between the esophagus and the trachea, esophagus and fiber mediastinum, leading to severe inflammation, exhausting the patient and lead to his death.Dysphagia - a violation of passage of food is dangerous without timely treatment, as the patient "dying of hunger".
Survey of esophageal cancer patients should include:
X-ray examination of the esophagus with contrast: allows to define the extent of the tumor, the degree of blockage of her esophagus, the presence of fistulas (leaking contrast mass in the airways or soft tissue), the nature of the tumor growth.
radiograph of the esophagus with contrast.The arrow indicates the tumor, causing narrowing of the esophagus.
esophagogastroscopy (EGD) - check the "inside" through a special device with a high magnification, this method allows a detailed study to examine the esophageal mucosa, gastric and duodenal ulcers and detect a tumor, determine its boundaries and take a slice for examination under a microscope.The method is safe and well tolerated by patients.In identifying small tumors in the early stages, it is possible to remove them using the same apparatus using short-intravenous anesthesia.
bronchoscopy (FBS) - through the endoscope inspection of the trachea and bronchial tree, reveals the germination of the tumor in these organs, the degree of compression of it, and the presence of a fistula between the esophagus and trachea.
Endoscopic picture of squamous cell esophageal cancer.Rebirth papillomavirus in squamous cell carcinoma.
CT scan: allows to define the boundaries of the defeat of the esophagus, the presence of growth in adjacent organs and metastases separated.
Ultrasound examination of the abdominal cavity is performed to rule out metastatic lesions.Ultrasound examination of the esophagus is used to specify the depth of tumor invasion, as well as when planning a minimally invasive (endoscopic) operations.
ultrasound picture esophageal tumors, the view through the gastroscope.
1 ultrasonic sensor, 2- tumor
arrow shows the tumor growth in the muscle layer of the esophagus wall.
laparoscopy, thoracoscopy - little traumatic operatsii- used to refine tumor incidence at the chest and abdomen.
esophageal cancer Treatment
esophageal cancer treatment rather difficult task.The difficulty lies in the large amount of surgery: the removal of the entire esophagus and its replacement with another body (a part of the stomach or colon), performed a cut of two cavities (thoracic and abdominal), transferred seriously ill, especially given the fact that patients suffering from esophageal cancer arehighly depleted (due to dysphagia and hunger).
leading treatment for cancer of the esophagus, of course, is surgery, but surgery offers hope for recovery of the patient.The operation can be performed only by 1-2, rarely three stages of the disease, due to the close proximity of bodies in the thoracic cavity and germination tumor vital structures that can not be removed.
At 3-4 stage of disease, when it is impossible to remove the tumor or the patient is severely malnourished, perform removal of gastrostomy: a hole in the stomach in the abdomen, through which feed the patient.
Currently, quite often use radiotherapy: esophageal irradiation with radioactive source (especially in stage 1), in patients with higher stage irradiation is applied with symptomatic purpose: to temporarily relieve pain, dysphagia.It is possible to use as an external (remote) and internal (via the esophagus) irradiation or combinations thereof.
prognosis of esophageal cancer can be favorable only at the stage of 1-2, provided adequate treatment (surgery, radiation).At 3-4 stage prognosis is extremely unfavorable, patients die quickly from exhaustion.